Provider Demographics
NPI:1447823877
Name:DOTHAN PEDIATRIC CLINIC, P. A.
Entity type:Organization
Organization Name:DOTHAN PEDIATRIC CLINIC, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & COLLECTIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-1881
Mailing Address - Street 1:126 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1980
Mailing Address - Country:US
Mailing Address - Phone:334-793-1881
Mailing Address - Fax:
Practice Address - Street 1:526 BOLL WEEVIL CIR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-4012
Practice Address - Country:US
Practice Address - Phone:334-308-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty